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General NPI Number Information
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NPI Number | 1467760678
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Entity Type | Organization
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Legal Business Name | J. RICHARD LAWRENCE
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 206 CLAY PITTS RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3423
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Country | US
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Telephone | 631-266-5061
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Fax | 631-266-5065
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Provider Business Mailing Address
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Address Line | 206 CLAY PITTS ROAD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3421
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Country | US
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Telephone | 631-266-5061
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Fax | 631-266-5065
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. JOSEPH RICHARD LAWRENCE
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Credential | D.D.S.
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Telephone | 631-266-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36108
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License Number State | NY
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